7.8: Sleep
- Page ID
- 228358
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SIDS and bed sharing issues
Risk Factors
- Babies are at higher risk for SIDS if they:
- Sleep on their stomachs
- Sleep on soft surfaces, such as an adult mattress, couch, or chair or under soft coverings
- Sleep on or under soft or loose bedding
- Get too hot during sleep
- Are exposed to cigarette smoke in the womb or in their environment, such as at home, in the car, in the bedroom, or other areas
- Sleep in an adult bed with parents, other children, or pets; this situation is especially dangerous if:
- The adult smokes, has recently had alcohol, or is tired.
- The baby is covered by a blanket or quilt.
- The baby sleeps with more than one bed-sharer.
- The baby is younger than 11 to 14 weeks of age.
Reducing the Risks
There have been dramatic improvements in reducing baby deaths during sleep since the 1990s, when recommendations were introduced to place babies on their back for sleep. However, since the late 1990s, declines have slowed.
In 2012, the Back to Sleep campaign became the Safe to Sleep campaign. Safe to Sleep aims to educate all caregivers about SIDS and safe sleep practices. Current recommendations to reduce the risk of SIDS and other sleep related causes of infant death:
- Always place baby on their back to sleep (for naps and at night).
- Use a firm and flat surface.
- Use only a tight fitting sheet on the sleep surface; no other bedding or soft items in the sleep area.
- Breastfeed.
- Share your room with a baby, but on a separate surface designed for infants (not your bed).
- Do not put soft objects, toys, crib bumpers, or loose bedding under, over, or anywhere near baby’s sleep area.
- Do no smoke during pregnancy or allow smoking around baby.
- Consider giving baby a pacifier.
- Do not let baby get too hot during sleep.
- Get regular health care (including vaccines).
- Avoid products that go against safe sleep recommendations, especially those that claim to prevent or reduce the risk of SIDS.
- Do not use heart or breathing monitors to reduce the risk of SIDS.[4]
Colvin, Collie-Akers, Schunn, and Moon (2014) analyzed a total of 8207 deaths from 24 states during 2004–2012 that were contained in the National Center for the Review and Prevention of Child Deaths Case Reporting System, a database of death reports from state child death review teams.6 The results indicated that younger victims (0-3 months) were more likely to die by bed-sharing and sleeping in an adult bed/on a person. A higher percentage of older victims (4 months to 364 days) rolled into objects in the sleep environment and changed position from side/back to prone. Carpenter et al. (2013) compared infants who died of SIDS with a matched control and found that infants younger than three months old who slept in bed with a parent were five times more likely to die of SIDS compared to babies who slept separately from the parents, but were still in the same room.
They concluded that bed-sharing, even when the parents do not smoke or take alcohol or drugs, is related to an increased risk of SIDS. However, when combined with parental smoking and maternal alcohol consumption and/or drug use, risks associated with bed-sharing greatly increased. (Lang)
The two studies discussed above were based on American statistics. What about the rest of the world? Co-sleeping occurs in many cultures, primarily because of a more collectivist perspective that encourages a close parent-child bond and interdependent relationship (Morelli et al, 1992). In countries where co- sleeping is common, however, parents and infants typically sleep on floor mats and other hard surfaces which minimize the suffocation that can occur with bedding and mattresses (Nelson et al, 2000).
There exists a lot of controversy about bed-sharing or co-sleeping during infancy. On the one hand there are distinctly different cultural, historical and geographical opinions and practices with regard to co-sleeping (Mileva-Seitz et al, 2017). On the other hand, there are numerous studies that suggest that bed-sharing increases the risk of SIDS (Carpenter et al, 2013). This risk is greatly increased if parents also use tobacco and alcohol, and depending on the location they sleep in (Blair et al, 2014). Of course, the practice also reflects families’ socioeconomic conditions (having the space to sleep separately – in a separate room or at least a crib) (Ward, 2015). Another factor that is interrelated is that bed-sharing is related to greater likelihood of breastfeeding (Das et al, 2013).
Sleep and Early Childhood
Along with food and water, sleep is one of the human body's most important physiological needs—we cannot live without it. Extended sleeplessness (i.e., lack of sleep for longer than a few days) has severe psychological and physical effects. Research on rats has found that a week of no sleep leads to loss of immune function, and two weeks of no sleep leads to death.
Recently, neuroscientists have learned that at least one vital function of sleep is related to learning and memory. New findings suggest that sleep plays a critical role in flagging and storing important memories, both intellectual and physical, and perhaps in making subtle connections that were invisible during waking hours.[5]
How Much Sleep Do We Need?
The amount of sleep an individual needs varies depending on multiple factors including age, physical condition, psychological condition, and energy exertion. Just like any other human characteristic, the amount of sleep people need to function best differs among individuals, even those of the same age and gender.
Though there is no magic sleep number, there are general rules for how much sleep certain age groups need. For instance, children need more sleep per day in order to develop and function properly: up to 18 hours for newborn babies, with a declining rate as a child ages. A newborn baby spends almost 9 hours a day in REM sleep. By the age of five, only slightly over two hours is spent in REM. Studies show that young children need about 10 to 11 hours of sleep, adolescents need between 8.5 and 9.25, and adults generally need between 7 and 9 hours.
Parasomnias
Evolutionarily sleep is a very interesting phenomemon, given that animals are much more likely to be preyed upon while they are sleeping and yet all animals appear to need sleep and sleep in different ways and for different amounts of time. Neurologically the brain coordinates sleep much like an orchestra is conducted through complex musical pieces. As the brain is developing in childhood, there is a greater likelihood of sleep disorders like sleepwalking, night terrors in children and most people outgrow these as they reach adulthood.
Sleepwalking (Somnambulism)
Sleepwalking (sometimes called sleepwalking disorder, somnambulism, or noctambulation) causes a person to get up and walk during the early hours of sleep. The person may sit up and look awake (though they're actually asleep), get up and walk around, move items, or dress or undress themselves. They will have a blank stare and still be able to perform complex tasks. Some individuals also talk while in their sleep, saying meaningless words and even having arguments with people who are not there. A person who sleepwalks will be confused upon waking up and may also experience anxiety and fatigue.
Sleepwalking can be dangerous—people have been known to seriously hurt themselves during sleepwalking episodes. It is most common in children, but it also occurs occasionally in adults. For adults, alcohol, sedatives, medications, medical conditions and mental disorders are all associated with sleepwalking.
Sleep Terrors and Nightmare Disorder
Sleep terrors are characterized by a sudden arousal from deep sleep with a scream or cry, accompanied by some behavioral manifestations of intense fear. Sleep terrors typically occur in the first few hours of sleep, during stage 3 NREM sleep. Night terrors tend to happen during periods of arousal from delta sleep (i.e., slow-wave sleep). They are worse than nightmares, causing significant disorientation, panic, and anxiety. They can last up to 10 minutes, and the person may be screaming and difficult to wake. In some cases, sleep terrors continue into adulthood.
Distinct from sleep terrors is nightmare disorder. Also known as "dream anxiety disorder," nightmare disorder is characterized by frequent nightmares. The nightmares, which often portray the individual in a situation that jeopardizes their life or personal safety, usually occur during the second half of the sleeping process, called the REM stage. Though many people experience nightmares, those with nightmare disorder experience them more frequently.[7]
Adolescent Sleep Health
According to the National Sleep Foundation (NSF) (2016), adolescents need about 8 to 10 hours of sleep each night to function best. The most recent Sleep in America poll in 2006 indicated that adolescents between sixth and twelfth grade were not getting the recommended amount of sleep. For the older adolescents, only about one in ten (9%) get an optimal amount of sleep, and they are more likely to experience negative consequences the following day. These include feeling too tired or sleepy, being cranky or irritable, falling asleep in school, having a depressed mood, and drinking caffeinated beverages (NSF, 2016). Additionally, they are at risk for substance abuse, car crashes, poor academic performance, obesity, and a weakened immune system (Weintraub, 2016).
Why don’t adolescents get adequate sleep? In addition to known environmental and social factors, including work, homework, media, technology, and socializing, the adolescent brain development is also a factor. As adolescents go through puberty, their circadian rhythms change and push back their sleep time until later in the evening (Weintraub, 2016). This biological change not only keeps adolescents awake at night, it makes it difficult for them to get up in the morning. When they are awake too early, their brains do not function optimally. Impairments are noted in attention, behavior, and academic achievement, while increases in tardiness and absenteeism are also demonstrated. Psychologists and other professionals have been advocating for later school times, and they have produced research demonstrating better student outcomes for later start times. More middle and high schools have changed their start times to better reflect the sleep research.[9]
In Sept 2019 California was the first state in the US mandating that no high school start before 8:30 am, and no middle school before 8 am went into effect based on this research and American Academy of Pediatrics research. Other states like New York went even further by suggesting that no school start before 8:30 am (Walker, 2022).
References:
Blair PS, Sidebotham P, Pease A, Fleming PJ (2014) Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK. PLoS ONE 9(9): e107799. https://doi.org/10.1371/journal.pone.0107799
Carpenter R, McGarvey C, Mitchell EA, Tappin DM, Vennemann MM, Smuk M, Carpenter JR. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. BMJ Open. 2013 May 28;3(5):e002299. doi: 10.1136/bmjopen-2012-002299
Colvin, J.D., Collie-Akers, V., Schunn, C., & Moon, R.Y. (2014). Sleep environment risks for younger and older infants. Pediatrics Online. Retrieved from https://pediatrics.aappublications.org/content/134/2/e406
Mileva-Seitz, V. R., Bakermans-Kranenburg, M. J., Battaini, C., & Luijk, M. P. C. M. (2017). Parent-child bed-sharing: The good, the bad, and the burden of evidence. Sleeping Medicine Reviews, 32 (2017), pp. 4-27, 10.1016/j.smrv.2016.03.003
Morelli, G., Rogoff, B., Oppenheim, D., & Goldsmith, D. (1992). Cultural variations in infants’ sleeping arrangements: Questions of independence. Developmental Psychology, 28, 604-613.
Nelson, E. A., Schiefenhoevel, W., & Haimerl, F. (2000). Child care practices in nonindustrialized societies. Pediatrics, 105, 75.
Rashmi Ranjan Das, M. Jeeva Sankar, Ramesh Agarwal, Vinod Kumar Paul, "Is “Bed Sharing” Beneficial and Safe during Infancy? A Systematic Review", International Journal of Pediatrics, vol. 2014, Article ID 468538, 16 pages, 2014. https://doi.org/10.1155/2014/468538
Walker, T. (2022). Later School Start Times More Popular, But What Are the Drawbacks? NEA Today. Retrieved March 28, 2023
Ward, T.C.S. Reasons for Mother–Infant Bed-Sharing: A Systematic Narrative Synthesis of the Literature and Implications for Future Research. Matern Child Health J 19, 675–690 (2015). https://doi.org/10.1007/s10995-014-1557-1
Attributions:
Child Growth and Development by Jennifer Paris, Antoinette Ricardo, and Dawn Rymond, 2019, is licensed under CC BY 4.0
Parenting and Family Diversity Issues by Diana Lang, 2020, published by Iowa State University is licensed under CC BY-NC-SA 4.0
[1] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0
[2] Image by the U.S. Department of Health and Human Services is in the public domain
[3] Image by the CDC is in the public domain
[4] Ways to Reduce the Risk of SIDS and Other Sleep-Related Causes of Infant Death by the CDC is in the public domain
[2] Image by Carlo Navarro on Unsplash
[3] Children’s Development by Ana R. Leon is licensed under CC BY 4.0
[4] Image by Andres and Antoinette Ricardo used with permission
[5] Children’s Development by Ana R. Leon is licensed under CC BY 4.0
[6] Image by Peter Griffin is in the public domain
[7] Children’s Development by Ana R. Leon is licensed under CC BY 4.0
[8] Image by the CDC is in the public domain
[9] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0
[10] Image by John-Mark Smith on Pexels